Many consumers still face confusion around health insurance coverage

Consumers need to be engaged and empowered when making decisions about their health coverage. Two recent studies suggest more can be done to help consumers sort through their health insurance options and select the best plan for their needs and budget. One study on 2016 marketplace open enrollment by the Georgetown Center for Health Insurance Reform analyzed data from a call center of assisters helping consumers select plans in the federally facilitated marketplaces. A second study focused on marketplace websites and found despite site improvements, consumers were still confused about several key aspects of selecting a health plan.

The Georgetown study, “Understanding the Consumer Enrollment Experience in Federally Facilitated Marketplaces,” analyzed data from the federally facilitated marketplace’s Assister Help Resource Center. The center fielded nearly 1,400 calls from consumers with questions about filing health insurance applications, enrollment scenarios and eligibility determinations. The study found many consumers are still confused about issues related to understanding benefit designs, how to use provider and prescription search tools, locating benefit information and plan deductibles.

“Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report for 2016,” released by the National Partnership for Women & Families reviewed the window shopping tools on HealthCare.gov and all of the state-based marketplace websites. The report found both HealthCare.gov and the state websites added new tools (including a customized cost estimator, an integrated provider directory and a simple prescription drug directory) during the third open enrollment period to support informed consumer decision-making and help consumers move beyond just looking at the premium when making plan choices.

However, the report found considerable opportunity for improvement. Specifically, the report calls out the need for tools to generate an out-of-pocket cost estimate that is more customizable and tailored to the individual medicines or treatments a consumer needs. The report also highlights HealthCare.gov’s addition of an integrated prescription drug directory to provide consumers with one tool to find out which plans cover their medicines. However, in states with their own marketplace website, 11 of 13 states did not have an integrated prescription drug search tool. While adding a prescription drug directory is an important step for those states, improvements are necessary to add cost-sharing information for each medicine to the tool.

While progress has been made to make marketplace websites more consumer-friendly, these reports show improvements are necessary to ensure consumers have a clear understanding of the choices in front of them when picking a health plan. Specifically, adding cost-sharing information to the prescription drug search tool is important to ensure consumers are engaged and empowered to make the best health care decisions for them and their family. Learn more about policy solutions to engage and empower consumers here and visit AccessBetterCoverage.org for helpful resources to navigate health care coverage.

Rebecca Davison Becca is a Director in the Policy and Research Department at PhRMA focusing on Medicaid, the Affordable Care Act and 340B. Prior to getting her Masters of Public Policy at the McCourt School of Public Policy at Georgetown University, she worked for the American Academy of Pediatrics and for Senator Christopher J. Dodd of Connecticut. In her spare time, Becca enjoys traveling and cooking and is a die-hard New York Yankees fan.